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TEPES 2008 Beach CME Conference Registration Using the Mail

TEPES has applied for 15 hours of Cat I CME and 18 NCNA contact hours.
Fee includes all meals and activities. (Note there is a guest fee for the Friday Night Beach Bash-new event this year.)
Cancellations will be honored if received by May 29, 2008($35 administrative fee deducted for all cancellations)
Only registered participants allowed to attend the educational sessions.
TEPES reserves the right to make scheduling changes without prior notification. Space is limited to 100 attendees.
You may print this page and use it to register for the 2008 TEPES Beach CME Conference


Name:____________________________________________________________________________

Credentials (i.e., PA-C, NP, etc):_________________

Home Address:_____________________________________________________________________

City:__________________________________________  State:_______  Zip:___________________
 
Home phone:_____________   Work phone:______________  E-mail:_________________________

Work Address:______________________________________________________________________

Please check ONE of the following:

  Early Bird Fees                                                                                    
Regular Fees

TEPES Member $135 (postmarked by March 31, 2008): ____             TEPES Member $175 ____
Non-Members    $175 (postmarked by March 31, 2008): ____             Non-Members   $200 ____

If you and/or guest(s) will be attending the Friday Night Beach Bash, complete the following:
Friday Night Beach Bash
I will attend (price included in registration) ___
I will not be attending the Shrimp-A-Roo ___
Adult Guests ____($35 for each ) Children (4-12 years) ____ ($12.50 for each) = Total: $_________

Grand Total Enclosed................................ $_________________________________
registration + fee for guest(s) at Friday Night Beach Bash 

Make checks payable to TEPES

Mail completed forms to: TEPES    C/O Michael Gough   669 Chaucer Drive   Winterville, NC 28590